PB2325: VALIDATION OF THE TRAIL SCORE TO PREDICT TOXICITY IN PATIENTS WITH DLBCL RECEIVING R-CHOP-LIKE THERAPY
Authors: Juan Carlos Caballero, Alberto Lopez-Garcia, Daniel Morillo, Maria Angeles Perez Saenz, Pilar Llamas, Raul Cordoba
Journal: HemaSphere (2023)

Topic: 19. Aggressive Non-Hodgkin lymphoma - Clinical Background: Diffuse Large B Cell Lymphoma (DLBCL) represents the most frequent hematological malignancy worldwide. First line therapy has remained unchanged for the last 2 decades. Consequently, toxicity related to treatment continues to be an issue for some of the patients. Whereas some scales and index have been elaborated to predict patient’s outcomes, variability between them makes it difficult to choose the most appropriate therapy for each individual. With TRAIL score, thanks to accessible daily clinical practice items, it is possible to predict which patients are at risk of stopping treatment prematurely or reducing their dose. With the values creatinine, albumin, Charlson Comorbidity Index and history of heart or vascular disease or diabetes, it uses an iterative trial-and-error modeling process to fit a logistic regression model, making possible to predict immunochemotherapy tolerability. Aims: Our principal objective is to validate on our cohort the TRAIL score for the treatment of DLBCL. As well, we intend to evaluate which variables are associated with patient abandonment or poor tolerance to treatment. We have used TRAIL variables, however, we have not applied the same formula, making a statistical analysis explained below. Methods: We performed a retrospective analysis of 132 patients with DLBCL diagnosis undergoing Rituximab-Cyclophosphamide-Doxorrubicine-Vincristine-Prednisone (R-CHOP), dose adjusted R-CHOP (mini-CHOP), and etoposide-prednisolone-vincristine-cyclophosphamide-doxorrubicin (EPOCH) between January 2018 and February 2022 at Fundacion Jimenez Diaz University Hospital. Qualitative variables were compared with the Chi-square test or Fisher’s exact test. Quantitative variables were compared with Student’s t test and Mann-Whitney U test. The calculation of the odds ratio (OR) and its 95% confidence interval (95%CI) is also shown. These OR and interval data are obtained with logistic regression models. SPSS 25.0 software was used for statistical analysis. Results: Median age of our patients was 66 years old ± 14.4 (23.0, 92.0). 98 patients underwent treatment with R-CHOP (74.2%), 3 with EPOCH (2.3%) and 31 of them with mini-CHOP (23.5%). 107 patients reached a complete response (CR) (81.7%), 4 a partial response (PR) (3.1%), 7 were refractory (5.3%), 3 of them showed progression of the disease (2.3%), and 10 of them were not valuable (7.6%). According to treatment tolerability, 109 patients didn’t need any dose reduction (87.3%) against 14 patients who required dose adjustment (11.4%). 16 patients had to delay any treatment cycle (12.7%) against 110 of them who received all treatment as planned (87.3%). According to treatment interruption, 118 patients (92.9%), didn’t need to stop it against 9 patients who stopped immunochemotherapy (7.1%). Interruption of treatment and dose reduction were infrequent values in our cohort. Nevertheless, we found that hypertension and hemoglobin levels were significantly related to dose reduction: OR 5.47 (1.66, 21.6) (p=0.008) for HTA and OR 0.74 (0.54, 0.99) (p=0.047) for hemoglobin (Table 1). For patients diagnosed with other analyzed comorbidities, no significant differences were observed. Summary/Conclusion: In our cohort, hemoglobin levels and arterial hypertension have an impact on chemotherapy dose adjustment. Nevertheless, we could not establish associations with treatment interruption. Further studies adding other lymphoma types and treatment regimens should be conducted to evaluate other possible associations.Keywords: CHOP, TRAIL, DLBCL